Malignant Melanoma Or Skin Cancer

Tags:

• A Man of The People
• A Raisin in The Sun
• According
• Action
• Administration
• Age
• Alexander The Great
• Analysis
• AnesThesia
• Animal Experimentation is Necessary
• Appearance
• Applied
• Area
• Background
• Beauty and The Brain
• Better
• Biological
• Black
• Blood
• Body
• Bone
• Brain
• Cancer
• Capacity
• Caring About Our Environment

Show more

Get document Get an original paper

Malignant melanoma or skin cancer

Melanoma also known as cutaneous melanoma or malignant melanomPigment to our skin, and when they proliferate inappropriately, a darker pigment is created in the affected areas, which are more common in the people of white complexion, and their location is generally in: trunk, neck and face. While in people of dark complexion it is more frequent in: palms of the hands, soles of the feet and under the nails. However, no body area is exempt from developing it since it is one of the cancers that spread rapidly through the lymphatic path to the deepest areas of the skin and this in turn anywhere in the body, as well asto the internal organs.

It is considered that the main risk factors that can predispose to melanoma development are:

• Solar radiation: since as we know we are constantly exposed to a large amount of radiation, but one of the most associated with the development of cancer cells is ultraviolet radiation which are considered invisible short wave rays that come from the energy emitted by our starSolar, it is worth mentioning that in our environment they are also present within the scope of medicine in special lamps or a laser beam and is used to eliminate germs, since it is considered a powerful bactericide or to help heal wounds.
• Cutaneous phenotype: It is the response of our skin to exposure to sunlight
• Geographic situation: Because the geographical location can determine how exposed we find the rays emitted by the sun and its effect on our skin, an example of this are the islands of San Blas where the Indians of the Cuna tribe live,which are genetically albinos and it has been observed that they have a greater incidence to develop malignant skin neoplasms before 30 years.
• Presence of nevings: As mentioned above, melanoma is closely associated with high pigmentary lesions.
• Inheritance: Only 10% of the cases diagnosed with melanoma are attributed to a dominant inheritance mode and incomplete penetrating,
• Hormones and pregnancy: since it has been observed that if melanoma develops during pregnancy, at the end of pregnancy can manifest again.
• Immunosuppression: This depends on the effective capacity of each person’s immune system, showing an increase in the incidence in patients who have undergone a kidney transplant.
• Age: there is greater incidence in people over 45 years old.
• Sex: It has been shown that there is both a better resolution and prognosis in women.

Types of melanomas

There are several types of melanoma of which some of them are referred to:

Malignant lentigo 

It affects the areas that are most frequently exposed to the sun for a very prolonged time such as: face, head, neck, hands and legs, it usually occurs between 60 and 70 years.

Start with an asymmetric spot, which begins to spread to form a nodule, presenting shades from brown, red or black. Surface extension: it can be found in any area of the body, it is the most frequent in the population of white complexion, appearing between 40 and 50 years. It starts as one or several superficial spots with irregular edges of slow growth which can last from months to years, they have shades ranging from brown, pink, gray or black. They constitute 70% of the diagnosed melanomas.

Acral

Mainly affects the soles of the feet, although it can be found to a lesser extent in the palms of the hands, fingers, genitals and mouth. It starts as a stain in which a tumor begins to develop within a few months, has scattered edges.

Nodular

It occurs in any area of the body, however, it is usually found in head and trunk, it appears more frequently in men than in women and usually occurs between 50 and 60 years. It is characterized by rapid growth, without the need to be preceded by a stain, but it can be seen as a tumor nodular lesion, it presents a wide variety of shades ranging from: brown, reddish, bluish and black.

Of mucous membranes 

It is common to find it in the genital, oral mucosa, of the digestive or conjunctive tract.

Demoplastic

It is rare.

Ocular

Although it is not related to sun exposure, as in most other types. The choroid, ciliary body and iris.

Melanoma stages

• Stage 0: The growth of abnormal cells is limited to the surface or external layer of the skin.
• Stage I: The tumor measures up to 2 mm, without dissemination to lymph nodes.
• Stage II: The tumor measures more than 2 mm, without dissemination of lymph nodes.
• Stage III: The tumor has spread to lymph nodes, where satellite lesions around the main lesion may appear.
• Stage IV: There is dissemination to other organs.

This malignant neoplasia develops as follows

First it must be emphasized that melanoma is an immunogenic tumor, which means that it is able to induce a local antitumor immune response, however it is not effective enough to eradicate it, since it also has the great ability to evade the immune system to the immune systemspread by lymphatic way favoring its dissemination (metastasis).

Melanin melanin granules (melanin granules) express in their membrane the GP100 protein which is necessary for maturation, which is occasionally recognized by cytotoxic T lymphocytes in the context of HLA-1, as well as the melan-a/ transmembrane proteinMAR-1 whose function is to favor the functioning of the aforementioned GP100 protein, for the proper development of melanin protectors within melanocytes, as well as tyrosinase, TRP 1 and TRP 2, proteins involved in the differentiation of melanin from melanin fromof tyrosine, which are recognized as specific tumor antigens favoring an activation of an anti-tumoral immune response.

Just as there are onco-feet antigens that are usually expressed in tumor cells or germ line cells, within these are proteins: Mage, Bage and Gage, which have the ability to reactivate in the case of the formation ofA tumor, contributing to the development of immunogenic proteins.

In 20% -40% of melanoma cases it has been found that they express the NY-ESO-1 antigen, in which it has been established that it produces a humoral and cellular response with the presence of specific T CD8+ lymphocytes.

Melanoma has managed to express high levels of FASL receptors, which as we know are associated with the trigger of the waterfall cascade to induce apoptosis, these receptors could contribute to induce apoptosis of the T -lymphocytes T cd8+ that react to the antigens expressed in the surface of thetumor cells and even those circulating, preventing the recognition of tumor cells.

In most cancers, not to say that all, there are very particular characteristics such as decreased HLA-I expression on their cell surfaces, avoiding the recognition of malignant cells by the T CD8+ lymphocytes and trigger the processing of saidAntigens by cytosolic pathways, through unnoticed antigens, this can also be presented due to the lack of coestimulation signals, in tumor cells capable of expressing in their HLA-II membrane and show an absence of the B7 molecules byAntigens presenting cells that interact with CD28 expressed in T lymphocytes, interfering with the activation of the immune response mediated by T CD4+lymphocytes, again this contributes both to the proliferation and dissemination of tumor cells.

Tumor cells can express factors in their membranes, which contribute to inhibit the function of T lymphocytes, among which are:

• PD-L1: which when joining the PD-1 protein (CD28) expressed in T cells, transmit an inhibitory signal, that is, it prevents T cells from destroying cancer cells.
• B7-H1: In itself it is an antiapopotic receiver, which receives a PD-1 signal to induce resistance against death mediated by T cells.

Both have the ability to stimulate the production of IL-10 in the T cells that they intercepted to avoid the recognition of tumor cells and thus induce the apoptosis of T cells with the ability to recognize tumor cells.

It is also known that the secret melanoma cytokines with a powerful inhibitory action on the immune system at the local level, within which they are: the Beta transformative growth factor, IL-6, IL-8, IL-10 and an immunosuppressive enzymeIndooleamine 2.3 dioxigenase (IDO), which is expressed in macrophages and facilitates immune tolerance, inhibiting cell proliferation of activated T lymphocytes, through the production of reactive oxygen species (ROS) and nitric oxide radicals (NO) .

A cellular melanoma line known as Iib-Mel-J has been described, which is characterized by contain-1) which binds to glyconjugados on the cell surface and extracellular matrix, and are able to avoid signs of death, proliferation and differentiation, with the aim of suppressing or counteracting the antitumor effector immune response. It has even been determined that dendritic cells that develop and differentiate in a micro-environment rich in GAL-1 are not able to perform an immune response of T cells, especially T CD8+ to remove tumor cells, but now create a rich balanceIn cytokines to establish a tolerant environment in places of tumor proliferation.

Diagnosis

We must start interviewing our patient to collect all the necessary data such as: knowing when the stain appeared, if it has changed their appearance, if it causes: itch, pain or if it has come to bleed. If you have a background of cancer, especially skin in your family, as well as if you have ease of tan or burns. As the melanoma ABCDE, since it can help us determine if the Nevo is normal, where each letter means:

• Asymmetry: Lunar or nevings with irregular shape, observing that by splitting our mole in half, these are completely different.
• Irregular edge: They are edges with cuts and waves.
• Color changes: since there is the presence of a large number of colors in the moles.
• Diameter: moles that have a diameter greater than 6mm.
• EVOLUTION: Here are the changes that the lunar has presented as time.

It is necessary to examine the rest of the body to see if there are other affected areas not recognized by the patient, as well as to examine the lymph nodes to notice any anomaly. It can be used to a dermoscopy or dermatcopy, which is a microscopy of epiluminescence (elM) to observe the skin at a greater increase, however if it has not yet been determined if it is a melanomaSkin where the area that will be extracted and local anesthesia will be applied, to send the sample to the laboratory, the appropriate technique must be established according to the area where it is located, example:

• Biopsy by scraping or tangential: the upper layers of the skin are scraped with a scalpel razor, it is usually used when there are slight suspicions that it is melanoma. However, this technique is already in decline since it can damage the integrity of melanoma, as well as give false positives.
• Puncture biopsy: an instrument is used, which is turned on the skin and this manages to penetrate all the layers of the skin, to extract a deep sample, then the place where the sample was taken.
• Biopsy by split or incision: This technique is generally used to evaluate a tumor:
• Screen: The entire tumor and a small portion of healthy skin are removed, this is the gold standard for the diagnosis of melanomas.
• Incision: A small part of the tumor is extracted. A scalpel is used to cut the skin’s thickness, at the end of the procedure the incision edges are sutured.
• "Optic "biopsies: in this type is the confectioning microscopy of reflectance (RCM), in which the extraction of a skin sample is not necessary.

In the event that melanoma has been disseminated, the following tests are recommended:

• Fine needle aspiration biopsy (FNA): It is usually used for large lymph node biopsies near melanoma, with the aim of determining if there is dissemination. A fine needle is used as the name of the technique indicates, to extract fragments from the ganglion or either from the tumor, local anesthesia is used when the ganglion is directly under the skin and can be felt.
• Surgical biopsy (by excision) of the lymph nodes: it can be used to remove a lymph node enlarged by a small split in the skin, local anesthesia is used if the lymph node is under the skin, or if the ganglion is deeperGeneral anesthesia is used.
• Centinel lymphatic ganglion biopsy: with the aim of knowing if cancer disseminated adjacent lymph nodes. In this technique a radioactive substance is injected into the area of melanomThe sentinel or guards ganglia.

Once we obtained our samples we proceed to laboratory tests:

• Immunohistochemistry (IHC).
• Hybridization in situ with fluorescence (FISH).
• Comparative genomic hybridization (CGH)
• GENETIC EXPRESSION PROFILES (GEP)

Image studies:

• Computed tomography: It allows us to detect whether a lymphatic ganglion is enlarged, or if there is lung or melanoma liver propagation.
• Magnetic resonance: MRI can be very useful to examine the brain and spinal cord.
• Positron emission tomography: It also allows you to detect if cancer has spread
• Blood analysis: Although it is not a diagnostic test for melanoma, it is used to establish the levels of dehydrogenase lactate (LDH) before treatment, since if melanoma has spread they will present high levels of this substance.

Prevention

• Avoid sun exposure for prolonged time.
• Use sunscreen.
• Wear protective clothing.
• Avoid tan artificially.
• Determine what type of skin you have, to notice alarming changes.

Treatment

This depends on the type and stadium of the tumor, as well as the patient’s health state:

• Surgery: It is the most common, which consists of the total removal of the tumor, next to a part of healthy tissue around it.
• Chemotherapy: It is the administration of anti -cancer drugs.
• Immunotherapy/ Biotherapy/ Biological Therapy: which consists of increasing patient’s natural defenses, usually the most used substances are interferons. Cellular vaccines have been created from murine models and in lower number of humans to introduce ex -living tumor antigens in dendritic cells, obtained from peripheral blood or bone marrow, to later inoculate the same patient from whom the dendritic cells were obtainedwith the cell vaccine to stimulate the response of T lymphocytes and other antitumorial immunocompetent cells.
• Radiotherapy: Local high intensity radiation is used, with the aim of destroying cancer cells and decreasing their proliferation, it is usually used for brain and bone metastases.